Course 4 - Otitele Medii

8/12/2019 Course 4 - Otitele Medii

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OTOLOGY- COURSE4

ACUTE AND CHRONICINFLAMMATIONS OF THE MIDDLE

EAR


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1. TUBO-TYMPANIC CATHARSETHIOLOGY: Occurs in children under 4 years Altered Eustachian tube function causes chronic inflammation of the

mucosa average house Causes:

- nasopharyngitis,

- acute and chronic adenoid hypertrophy,- hypertrophy of turbinates- polyps,- benign and malignant tumors, sinus disease,- anatomic aspect of tube-horizontal,- ogival palate ,- choanale malformations,- posttraumatic scar-post adenoidectomy-bride,- allergies,


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2. TUBO-TYMPANIC CATHARS

Symptomatology : 3 stages:

- simple tube obstruction

- tube obstruction with transudate in middle earcavity functional sequelae Clinical symptomatology :

1. ear obstruction2. autphonia - dimmable, and it is improved

by swallowing, blowing nose3. low tone ear noise


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Clinical examination :1. Discrete hammers and SchrapnellMembrane2. Tympanic aspiration, and its mulat onosicular chain

3. Leveling hammer4. Whitish-gray color5. Mobile liquid bubbles in the tympaniccavity6. Thickened secretions that determine thelevel of the liquid-glue ear

Nasopharynx and rhinoscopy orendoscopy examination!!!


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Diagnosis : Permeability of Eustachian Tube its doing

with Valsalva and Toynbee Maneuver

To performed a Tube catheterization is usedITARD PROBE

Radiological examination

Tympanogram: flattened in shape curve ornegative curves

Audiometry: transmission hearing loss


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TREATMENT: Removing rhinophariyngeal causes

1. Fluid accumulation: - transtympanaldrainage -diabolo

2. Antinflammatory drugs3. Nasal decongestans

4. Aerosols5. Mucolytics6. Cortisone


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TUBE SYNDROME

Definition: is the impossibility to close the tube Symptomatology : to inspiration is produce an ear

noise , acuphaena, and hearing loss Clinical examination : the membranic tympan aspect

of flag waving at each respiratory movement Treatment :

- insuflations of boric acid or salicylic acid acid thatproduce reflex contraction of Eustachian Tube -

- Electrical Cauterization of Eustachian Tube in therhinopharyngeal opening hole

- injection with teflon


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ACUTE MIDDLE EARINFLAMMATIONS

EUSTACHIAN TUBE


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ACUTE OTITTIS MEDIA

CLASIFICATION:1. MICROBIAL ACUTEOTITIS MEDIA

- Acute congestive otitis media- Supurate Otitis media( Otitis media with

effusion)

2. NON MICROBIAL ACUTEOTITTIS MEDIASerous Otitis media


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MICROBIAL ACUTE OTITIS MEDIA

Ethiology: is produce by Pneumococ, Haemophilus,Stafilococ

Pathological anatomy:

1. The congestive phase : catarrhalinflammation suppurated stage withpururlente collections spontaneousperforation or surgical drainage paracentes is

2. Persistent chronic suppuration 3. Osteitis with mastoiditis


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Cauze favorizante:1. Eustachian Tube disffunction

2. Rhinopharyngeal inflammations

3. Systemic viral infections: measles(rujeola),influenza(gripa), chickenpo(varicella)

4. External Traumatisms on the TM with TMPerforation


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Symptomatology:- fever ,pain, autophonia, hearing loss, tinnitus withlow frequencies

Othoscopical examination : - Congestive stage : intense vascular drawing of

hammer handle, or TMin the posterior andsuperior region

-Catarrhals stage -retracted TM absence of thelight reflex( POLIZER BRIGHT TRIANGLE), reduction ofthe mobility of TM

Functional Examination : BEZOLD TRIADE, moderatetransmission hearing loss, whispering voice(vocesoptita) under 5 m

Bezold Triade : Rinne negative on the same site withthe inflammation , Weber lateralized on the affectedsite, prolonged Schwabach test, for low frequency


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ACUTE SUPPURATED OTITIS MEDIA(acute otitis mediawith effusion)

Definition : It is a suppurative process to the all middle earscompartments

Anatomo-pathologically aspects: hyperplasia of the middleear mucous


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SYMPTOMATOLOGY:- It is an evolution stage of one catharallis otitis media

, when the secretion is transformed from serous andmucous in purulent(suppurative)

- clinical symptoms: ear pain,pulsation in the ear withirradiation on the dental arch fever 39-40

2 Phase: before perforation and after perforation


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ACUTE SUPPURATED OTITIS MEDIA(acute otitis mediawith effusion) BEFOR PERFORATION

Clinical examination :- diffused hyperemia of TM intensive red TM- intensive vascularisation of hammer handle- the congestion is extended to the EAC trough theTympanic Ring- light reflex is ersed(wiped)- the surface of TM is matt- sometimes pain to pressing the mastoid =mastoidean reaction

- transmission hearing loss, with acouphena anddizziness (vertigo) , that is produce by labyrinthirritation

- fever, Febr, fatigue (tiredness), leukocytosis andtachycardia


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after perforation

IS A ACUTE SUPPRATED OTITS MEDIA PERFORATION CAN BE SPONTANEOUS OR PROVOCATED-

PARACENTESISClinical examination :

Pus in EAC, that can be purulent(supurative) and bloody oryelow-greenish, it does not smell

Congestive TM, middle perforation with irregular margins


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Evolution: - after 10-14 days with correct treatment we see that the

suppuration beganes to yield

- After more than 7-10 days it will produce the healing Complications :

- meningitis

. Labyrinthitis

- mastoiditis

- become chronic


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ACUTE SUPPURATED OTITIS MEDIA

Classification :

1. after evolution (development): supracute and subacuteforme

2. after perforation aspects- middle perforation( mezotympanic perforation)- perforation to Shrapnell Membran anterior-superior

Prussak and posterior-superior Troeltsh

3. after according to the nature of pathogen- pneumococ- staphylococ

- enterococ


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ACUTE SUPPURATED OTITIS MEDIA

Diferentialle diagnosis:

1. External otitis media2. Inflammation of TM- MIRINGITIS3. zona zoster auricullaris4. Chronic otitis media in acute forme

Treatment:- to relieve the pain antialgic drugs- antiinflammatory drugs- antibiotics after microbiological examination of secretion- nasal dezobstruction

Evolution: 10 -14 days with treatment is produce the healingIn case of perforation persistence is a high risk of chronicity and

recurrence


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ACUTE SUPPURATED OTITIS MEDIA to children

Is very frequently Sometimes it can be unobserved

othologycal examination is very important Every fever stage needs to have anothological examination!!!

it is bilateral


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OTITIS MEDIA INFECTIOUS AND CONTAGIOUSDISEASES

COMPLICATION OF INFECTIOUS ANDCONTAGIOUS DISEASE

1. Scarlet fever - 2 formes: earlier in first 2-3 days,necrotizing

2. Measles 3. Influenza- blestering on the tympanic membran

surface, bleeding ear tympanic membran 4. Erizipelas - blistering plaque in EAC and on TM suface 5. Whooping cough(pertusis) 6. Mumps- is associated with neurosenzorial hearing

loss, by affecting cochlea


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Acute inflammation of Tympanic membrane


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INFANTS OTHOMASTOIDITIS

Ethiology : Nasal and rhinopharyngeal infections General poor hygiena Prematurity Eustachian Tube conformation

Pathological anatomy :

Inflammation with an implication of Inflamaia cu afectarea tuturoresuturilor urechii medii Clinical Forms: latent and manifestsClinical picture :

Insomnie

Fever Restlessness(agitation) Digestive disorders Weight loss


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Clinical examination : Nasal secretions Pain on the pressing tragus Diffuse hyperemia of TM Bulging of TM pressing the Ear pavillion forward and down It is necessary to performe tympanotomy- suppurative

secretion

Clouding mastoid


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Latent(hidden) form It appeares to dystrophic children It appears than a toxicosis form : nervous syndrom, digestive

syndrom, dehydration

Clinical Examination:- it is possible to have less noisy signs- posterio-superior wall of EAC falling- clouding mastoid

Evolution : Endocranial complications


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TREATMENT

Earlier drainage

Combating associated infections TYMPANOTOMY Antibiotics Nasal desobstruction sol ANTROMASTOIDECTOMY Dezobstruante nazale


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ACUTE SUPPURATE OTOMASTOIDITISEtiopathogeny: middle ear supurative process, that is transmited to mastoid trough

aditus ad antrum

Clinical Form : acute not exteriorities latent form, acute exteriorities, infantsototmastoiditis


Initially Form: diffuse TM hyperemia hiperemia, mucosa thickening, suppuratesecretions

Second Form: invading the mastoid bone, mastoid empyema, bone thickening-externalizing

Clinical examination:

Pain on palpation mastoid Intense congested,and bulging of the TM TM perforation by pulsed pus leaking Gelle-fistulla is a fistulla of EAC, ptosis the posterior superior wall of EAC Transmission hearing loss

Clouding mastoid


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ACUTE SUPPURATE OTOMASTOIDITIS

Clinical Form:

Supacute form -catching simultaneously middle ear and mastoid Subacute form- headache, purulent otoree Apparently primitive, minimal changes and major mastoid TM

Complications : Otogena meningitis Facial Nerve Paralysis

Epidural abscess Labyrinthitis


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CHRONIC OTITIS MEDIA

Definition : chronic inflammatory process of middle ear and mastoid

It is a polymicrobial pathology


1. Damage to the tympanic membrane: perforated TM-

mezotimpanale or epitimpanale, respectively pars pars flaccid-membrane voltage or Shrapnell, free or adherent edges 2. Mucosal lesions: cellular infiltration and formation microchiste,

polyps grains 3. Bone lesions: vascular thrombosis in the osicular chain bone

necrosis ... Osteitis.


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CHOLESTEATOMATOUS OTITIS MEDIA WITH EFFUSION

Perforaie marginal a MT, cu henierea epiteliului CAE SKIN IN THE WRONG PLACE

Clasificare: colesteatom n sac herniar, colesteatom extensivAtica- punct de plecare, invadarea membranei ShrapnellAntrul mastoidian- posibilitate de extindere spre mastoid Lezarea lanului osicular de procesele osteitice Casa medie- leziuni extinse ale canalului facialExtindere spre canalul facialului sau canal semicircular


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Acute exteriorized Mastoiditis

topirea septurilor mastoidiene i formareaflegmonului endomastoidian

Abces subperiostal superiorAbces retroauricular postero-superiorsubperiostal

Otomastoidita temporal Abces substernocleidomastoidian BEZOLDOtomastoidita occipital Otomastoidita jugodigastric Petrozita sau petroaticitaSINDROMUL GRADENIGO- OMS, cefaleeintens, paralizia oculomotorului extern


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COLESTEATOM ATICAL


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COLESTEATOM CAE I CASA MEDIE


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Semne clinice ale colesteatomului

Otoree purulent fetid Evoluia continu a otoreei Otoree insensibil la tratament local i general Otoragie

Polipi n casa medie sau granulaii, lamele decolesteatom dispuse concentric Hipoacuzie de transmisie HP sau HM. Acufene- ureche nfundat

Paralizia facial Perioade de renclzire Complicaii endocraniene


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DIAGNOSTICUL POZITIV AL COLESTEATOMULUI

Examen otoscopic Ex audiometric RTG sau CT mastoidian

Dup tipul de leziune Natura leziunilor timpanale


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TRATAMENTUL COLESTEATOMULUI

TRATAMENT CURATIV: - suprimarea cauzeicare l-a produs TRATAMENT SIMPTOMATIC- dezinfectante

nazale i rinofaringiene, soluii localeantiseptice TRATAMENT CHIRURGICAL-

ANTROMASTOIDECTOMIA LRGIT tehnic nchis sau deschis


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OTOREEA TUBAR SIMPTOMATOLOGIE

- otoree mucoas, intermitent - surditate de transmisie moderat 10 -15 dB

EXAMEN OBIECTIV:- perforaie antero -inferioar - sediu marginal

- margini bine delimitate- prin perforaie se vede mucoasa cavit timp hiperemic,congestionat

EVOLUIE I PROGNOSTIC:- otoree rebel la tratament - nlturarea cauzelor de vecintate

Complicaii: - otita extern - iritaia CAE

Tratament: curativ i simptomatic


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ATICITELE

Caracteristici:1. Localizare atical 2. Debut i origine obscure 3. Fr antecedente auriculare semnificative 4. Evoluia lent a unui colesteatom primitiv Anatomia patologic:

perforaie marginal la nivelul membraneiShrapnell

Perforaie mic cu leziuni osoase


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ATICITELE

EX CLINIC LA DEBUT

Hipoacuzie uoar rmne mult timp nemodificat Cefalee occipital Secreii auriculare minime Evoluie silenioas, lent Secreie clar ,fetid CAE normal PERFORAIE LA NIVELUL MEMBRANEI SHRAPNEL

Extragere de lamele de colesteatom din atic Manevra Valsalva negativ- blocaj atical Palparea mastoidei negativ


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ATICITELE EX. CLINIC IN PERIOADA DE OTOREE:

Hipoacuzie net lezarea lanului osicular CAE normal Lamele de colesteatom n atic

Mucoas granulat, hiperemic CLASIFICAREA ATICITELOR:1. Anterioare cu perforaie mic 2. Posterioare cu perforaii largi, retromaleare 3. Polipoase4. Colesteatomatoase5. Perforaii asociate


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ATICITELEForme complicate:

1. dureroas 2. vertiginoas 3. complicat cu paralizie de facial

Evoluia: Supuraie continu,cu complicaii endocraniene Prognostic:

Afectarea auzului, complicaii endocraniene Tratament: chirugical- antroaticotomie,

antromastoidectomie


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ANTROATICOTIMPANITELE

Definiie: proces supurativ cu participareaaticii, antrului, otoree fetid, purulent,colesteatomatoas, leziuni osiculare,persistena i tenacitatea supuraiei, eecultratamentului conservator


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ANTROATICOTIMPANITELE


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OTOMASTOIDITA CRONIC SUPURAT

Anatomie patologic: Proces osteitic, asociat cu un proces supurat Cuprinde toate cavitile UM Simptomatologie:

I. Mastoidita cr. simpl 1. forma comun- sm clinice reduse, otoree, durere lapalparea mastoidei

2. forma fistulizant- forma Gelle- fistula atico- timpanic,prbuirea CAE perete postero -superior

II. Mastoidita cronic renclzit complicaii grave endocraniene, labirintite, petrozite,

abcese, paralizie de N. Facial.


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V mulumescpentru rbdare!

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Course 4 - Otitele Medii